* Correspondence: Arash Seifi, Department of Infectious Diseases, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. E-mail: a-seifi@sina.tums.ac.ir, Tel: 0098 2161192811, Fax: 0098 2166581598
Received 2021 Jan 1; Revised 2021 Feb 16; Accepted 2021 Apr 8.This is an Open Access article distributed under the terms of the Creative Commons Attribution License, (http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Proper hand hygiene is the most important action in preventing healthcare-associated infections (HCAIs). In this study, the knowledge and perception of hand hygiene assessed among nurses as the most exposed personnel to patients.
In this analytical cross-sectional study, the nurses working in different wards of a collegiate tertiary hospital in Tehran were investigated by standardized WHO questionnaires.
Of the 101 participating nurses 89 (88.1%) were females. 81 (80.2%) had received formal related training. The 69 respondents estimated the mean prevalence of HCAI to be 38.91% and 98 (97.1%) considered hand hygiene an effective prevention in this regard. 78 (77.3%) perceived hand hygiene as the center priority; 82, 83 and 79 of participants would think that good hand hygiene matters for their superiors, colleagues and patients, respectively. The practice of hand hygiene was stated to be difficult by 48 (47.5%) respondents. There was no significant difference in self-reporting of hand hygiene practice among nurses in age (P=0.68), the degree of education (P=0.574), work experience (P=0.64), nor their wards (P=0.131). There was a significant reverse relationship with the supposed difficulty level of doing hand hygiene (P=0.049). The mean score of the nurses' knowledge was 66.53 (±9.41) based on the answers to the questions of the knowledge questionnaire.
Knowledge and perception of hand hygiene, as this study showed, might not to be satisfactory; therefore, planning to improve these indicators and regular monitoring using standard tools is necessary for all healthcare centers.
Key Words: Hand hygiene, Knowledge, Perception, Cross infectionInfection prevention and control (IPC) is a core component of patients’ safety program all around the world (1). Healthcare-associated infections (HCAIs) affect 1.4 million people worldwide each year (2). It has been estimated that 20 to 40 percent of HCAIs are preventable (3, 4). Appropriate hand hygiene during patient care is an important action for preventing and controlling infections (2). However, international compliance of hand hygiene among health care providers around the world is unacceptably low (5, 6). HCAIs lead to high mortality and cost in almost all countries especially in developing countries such as our country, Iran (7). Appropriate nurses’ hand hygiene has an important role in preventing HCAIs; therefore, the necessary information about hand hygiene should be provided for them. It is also known that the knowledge and perception of nurses about hand hygiene affect their performance (8).
WHO suggests a questionnaire to evaluate knowledge and perception about hand hygiene as the following categories: individual's perception about the risk of not practicing hand hygiene in relation to HCAI, individual’s perception about the control on his/her behavior resulting from the exerted pressure by a colleague (colleagues or higher officials). HCW knowledge monitoring is also possible with this organization's proposed questionnaire. The questionnaire also considers the examining of individual information about five hand hygiene situations and individual’s background information on different methods and their preferences relative to each other and the selected model in specific situations (9).
In this study, we reviewed the levels of knowledge and perception of nurses (who have the most contact with patients) in a tertiary referral collegiate hospital in Tehran, Iran.
In this analytical cross-sectional study, 101 nurses working in different wards of a tertiary referral collegiate hospital in Tehran were investigated. The judgmental sampling method was used for sampling. Different units of the hospital were considered as categories, and the samples (number of nurses) selected from each ward were based on the proportion of the nurses of that ward to the total nurses of the hospital. In this study, the evaluation tool was the questionnaire prepared and recommended by the World Health Organization (9). The questionnaire was translated to Persian language and localized to a better understanding by the participants. The questionnaire including demographic data such as age, sex, degree of education, profession, ward, and work experience; Knowledge part including questions about training courses, use of alcoholic handrub, source of HCAIs’ germs and transmission routes, hand hygiene methods and situations, time needed for proper handrub or hand wash; Perception survey was on the estimation of HCAI rate, effect of hand hygiene on HCAI prevention and patient outcome, priority of hand hygiene in the center, the effect of staff training and others. The participants who entered the study, were assessed by completing the questionnaire. This study was conducted in the emergency unit, ICU, NICU, internal medicine wards, infectious disease ward, pediatric and surgery units of a collegiate tertiary hospital in Tehran, during 2019.
Statistical analysis: The obtained results for the quantitative variables are in the form of mean and standard deviation (mean ± SD). Comparison among quantitative variable is done by t-test or in the presence of not normal distribution, it is done by Mann-Whitney U test. Comparison of qualitative has been performed by chi-square test or Fisher’s exact test. Correlation among the quantitative variables has been examined through Pearson correlation coefficient and Spearman rank correlation. In determining the differences of the indices in the presence of the basic characteristics of patients as confounding factors, multivariate logistic regression analysis was used and its results were stated as odds ratio (95% confidence interval). SPSS Version 21 and SAS Version 9.1 were used for statistical data analysis. The significance level was considered less than 0.05.
Research Ethics: In this study no intervention was done, and no cost was imposed on the participants. Researchers, in all stages, adhered to the principles of the Helsinki manifesto and the Ethics Committee of Tehran University of Medical Sciences as medical student’s dissertation with referral No.32152.
General Data: One hundred and one nurses participated in this study, included 12 (11.9%) men and 89 (88.1%) women. The mean age was 33.3 (±7.56) years. The mean of work experience was 9.05 (±6.8) years.
Perception Survey: Eighty one (80.2%) nurses told they were already trained for proper hand hygiene but 20 (19.8%) nurses claimed they were not trained formally before. Ninety six individuals (95%) used alcoholic handrub (AHR) as a routine practice. According to the nurses’ viewpoint, they estimated 38.91% (±18.90) of patients were affected by HCAIs. The effect of HCAIs on patients’ outcome was assumed very high (19.8%), high (68.3%), low (10.9%), and very low (1%) based on the nurses’ answers. Almost all nurses accepted the high effect of hand hygiene in prevention of HCAIs. The priority of hand hygiene in the hospital (expressed by nurses) showed in figure1 . Performing proper hand hygiene assumed to be easy for 53 (52.5%) nurses and it is considered to be difficult for 48 (47.5%). The nurses thought hand hygiene compliance among nurses was 60.31% (±25.56). According to the nurses’ attitude, 81% of hospital authorities were concerned about the personnel’s hand hygiene. They thought the colleagues mattered 82.2% about their proper hand hygiene. The amount of importance given by patients to nurses’ proper hand hygiene was 78.2%. In overall, 76% (±17.6) of nurses claimed doing proper hand hygiene.